Care Plan Team Meeting(As updated during meeting)

André Boudreau (a.boudreau@boroan.ca)

Laura Heermann Langford (Laura.Heermann@imail.org)

2011-02-09 (1)

HL7 Patient Care Work group

NOTES:Action items can be found on slide 27This document will be updated and polished over a few meetings.

Page 2

Participants- Meetg of 2011-02-09

Name email Country Yes No Notes

André Boudreau a.boudreau@boroan.ca CA Yes

Laura Heermann Langford Laura.Heermann@imail.org US Yes

Stephen Chu stephen.chu@nehta.gov.au AU No

Peter MacIsaac peter.macisaac@hp.com AU No

David Rowed david.rowed@gmail.com AU No

Adel Ghlamallah aghlamallah@infoway-inforoute.ca CA Yes

William Goossen wgoossen@results4care.nl NL No

Anneke Goossen agoossen@results4care.nl NL No

Ian Townsend ian.townend@nhs.net UK No

Charlie Bishop charlie.bishop@isofthealth.com UK No

Rosemary Kennedy Rosemary.kennedy@jefferson.edu US Yes

Jay Lyle jaylyle@gmail.com US No

Margaret Dittloff mkd@cbord.com US Yes

Walter Suarez walter.g.suarez@kp.org US Yes

Peter Hendler Peter.Hendler@kp.org US yes

Ray Simkus ray@wmt.ca CA Yes

Audrey Dickerson adickerson@himss.org US Yes

Ian McNicoll Ian.McNicoll@oceaninformatics.com UK Yes

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Participants- Profile notes - 1

Name Country Organization Notes

André Boudreau CA Boroan Inc. (Consulting)Chair, Individual Care SCWG No. 2 (pan Canadian Standards Collaborative Working Group); project manager – standards projects; HL7 EHR and PHR WG

Laura Heermann Langford

USIntermountain Healthcare

RN PhD,: Nursing Informatics; Emergency Informatics Association, American Medical Informatics Association; IHE

Stephen Chu AUNEHTA-National eHealth Transition Authority

Lead Clinical Information Architect ; co-chair HL7 Patient care WG; vice-chair HL7 NZ

Peter MacIsaac AU HP Enterprise ServicesMD; Clinical Informatics Consultant; IHE Australia; Medical Practitioner - General Practice

David Rowed AU Family medicine practice MD;

Adel Ghlamallah CA Canada Health InfowaySME at Infoway (shared health record); past architect on EMR projects

William Goossen NL Results 4 Care B.VRN, PhD; -chair HL7 Patient Care WG at HL7; Detailed Clinical Models ISO TC 215 WG1 and HL7 ; nursing practicioner

Anneke Goossen NL Results 4 Care B.VRN; Consultant; Co-Chair Technical Committee EHR at HL7 Netherlands; Member at IMIA NI; Member of the Patient Care Working Group at HL7 International

Ian Townend UK NHS Connecting for Health

Health Informatics; Senior Interoperability Developer, Data Standards and Products; HL7 Patient Care Co-Chair

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Participants- Profile notes - 2

Name Country Organization Notes

Charlie Bishop UK iSOFT Product Manager - Information & Integration ; HL7 Patient care WG

Rosemary Kennedy USThomas Jefferson University School of Nursing

RN; Informatics; Associate Professor; HL7 EHR WG; HL7 Patient care WG; terminology engine for Plan of care;

Jay Lyle US JP Systems Informatics Consultant; Business Consultant & Sr. Project Manager

Margaret Dittloff US The CBORD Group, Inc.RD (Registered Dietitian); Product Manager, Nutrition Service Suite; HL7 DAM project for diet/nutrition orders; American Dietetic Association

Walter Suarez US Kaiser Permanente MD, MPH; Director of Health IT Strategy; national priority for transition of care; WEDI- Workgroup for Electronic Data Interchange

Peter Hendler US Kaiser Permanente MD; informatics; lead in KP convergent terminology; SNOMED CT

Ray Simkus CABrookswood Family Practice

MD; Family medicine; EMR user; active meber various standards WG in Canada; on IHTSDO Contents Committee

Audrey Dickerson US HIMSS

RN, MS; Standards Initiatives at HIMSS; ISO/TC 215 Health Informatics, Secretary; US TAG for ISO/TC 215 Health Informatics, Administrator; Co-Chair of Nursing Sub-committee to IHE-Patient Care Coordination Domain.

Ian McNicoll UK Ocean Informatics Health informatics specialist; Formal general medical practitioner;OpenEHR; Slovakia Pediatrics EMR; Sweden distributed care approach

Page 5

Meeting(s) Objectives

• Agree on where we are and where we want to go• Agree on the approach to get there• Identify what is available and what is missing• Identify tasks and develop realistic work plan• Agree on roles and mechanics

Page 6

Agenda – (multiple meetings)

• Welcome and roll call• Objectives of the meeting• Care plan status update• Objectives of this phase• Methodology to be followed• What has been done• Gaps• Team and roles• Conclusion

Next steps Next meetings

Page 7

CARE PLAN STATUS UPDATE

Page 8

Where we are

• We have a Care Plan DSTU• We have an approved March 2010 Project Scope Statement

Questions were raised and discussed regarding development processes, artefacts to be created and the types of ballots

• Use cases and storyboards have been collected Some are on the wiki and HL7 PC WG page Not standardized, not reviewed More would be available

o Canada (Blueprint 2015)

• We have details on the methodology (see later)• Ask William Goossen for more details (add on next page)

Page 9

Where we are (William?)

Page 10

Notes from Jay Lile – 2011-02-03

1. INFORMATION: The DAM should inform a constrained model (DIM/DMIM/RMIM), which is then used as the basis for specifications (CDA, message, etc.). If we build a DAM, we'll presumably use it to update the Care Provision DIM. The updated DIM should be in the list of balloted deliverables. (This is much clearer in PSS 4d, but the sections should be in harmony.)

2. SCOPE ISSUE: We will also need to determine whether the DAM scope should be restricted to the care plan or should reverse-engineer the entire Care Provision DIM. 

3. PSS (Project Scope Statement) UPDATE: The Scope section (4a) discusses semantic scope, but it does not lay out the scope of work. I'd suggest that the text currently in 2a be removed from 2a, expanded, and added to 4a. 

4. GUIDELINE: The term "DSTU" is being used to refer to deliverables. I find that confusing: DSTU is a status, not an artifact. It would be clearer to me if artifacts were referred to as messages, cda documents, DAMs, and DIMs, and ballot status were used to modify those artifacts. E.g., "the purpose of this project is to develop a Care Plan CDA document, with all necessary antecedent artifacts [list them], and to ballot this document as DSTU." 

5. DELIVERABLES: Modeling the information space will almost certainly be useful, but I'm still in the dark about the use cases.  Under what circumstances is it necessary to communicate a care plan? For what business purpose are organizations paying their employees to volunteer and develop this standard? 

6. PSS UPDATE: External collaboration (6) could use more detail. That would also make it less necessary to mention this slightly distracting information in previous sections.

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WHERE WE WANT TO BE (TARGET)

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Objectives of this phase

• Get more familiar with HL7 chain of deliverables (HDF)• Consolidate and clarify business and clinical requirements

Under what circumstances is it necessary to communicate a care plan?

Include clinical guidelines Distributed care planning as in Sweden: meta data needed For what business purpose are organizations paying their

employees to volunteer and develop this standard?

• Scope: decide whether the DAM scope should be restricted to the care plan or should reverse-engineer the entire Care Provision DIM

• Assemble use cases and analyze• ?Develop DAM• Update objectives once we have a better handle on our

methods

Page 13

Deliverables (to be updated after a few weeks of travel…)

• NB: Care Plan wiki to be used for all documents Laura and André to manage?

• See HDF Domain Analysis- later• Project Scope Statement

Eventually…

• DAM storyboard, use cases, structural models, dynamic models

• Care Plan CDA?• Care Plan v3 message?

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METHODOLOGY: HOW TO GET THERE

Page 15

Guidelines

• Use approved HL7 methods: HDF- DAP All agree

• We need to familiarize ourselves with the approach• Resources

HDF_1.5.doc (Jan 2010)

CIC DAM Development Guide HL7 PC Cambridge 2010.pptx Format for use cases, storyboards, activity diagrams and

interaction diagrams - HL7Wiki.mht

• Examples EMS Domain Analysis Model VOORBEELD.pdf

Page 16

HDF- Domain Analysis Overview

act 3: Domain Analysis Ov erv iew

Analyze Business Context

(from 3.4.1 Business Context Analysis)

Analyze Use Cases

(from 3.4.2 Use Case Analysis)

Analyze Process Flow

(from 3.4.3 Process Analysis)

Analyze Information Exchanged

(from 3.4.4 Information Analysis)

Analyze Business Rules

(from 3.4.5 Business Rules Analysis)

Story board

(from 3.7 Artifacts)

Use Case Analysis

(from 3.7 Artifacts)

Process Flow

(from 3.7 Artifacts)

Information Model (Analysis)

(from 3.7 Artifacts)

Glossary

(from 3.7 Artifacts)

«optional»Business Rules Description

(from 3.7 Artifacts)

Business Trigger Analysis

(from 3.7 Artifacts)

DAM Approv al

Publish DAM

ProjectApproved

Business Requirements

«outcome»«outcome»

Source: HDF_1.5.doc, page 37

Page 17

WHAT HAS BEEN DONE

Page 18

What do we have (assets)

• Approved PSS that needs revision when we are ready• Use cases and storyboards (next page)• Glossaries: HL7, EHR WG• CEN Continuity of care P1 and P2

CEN docs are published Information model and processes and workflow

• Care plan DSTU of 2007• IHE models of the PPOC (Patient Plan of Care)• To be updated with a good inventory (see next page)• NB: we need all the assets in one location (or at least links to

other locations would be found in that spot)

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Use Cases and Storyboards on Hand

• Care Plan Storyboards - HL7Wiki.mht• Care Plan Use cases - HL7Wiki.mht• CarePlanPneumoniaStoryboard.doc• Goossenetal2004Jamia-nursingprocessHL7-186.pdf• Care coordination usecases v-9 IHE Australia.doc• CarePlanTopicUseCasesDiabetesCare22-11-2010.doc• IHE-PCC_Profile-

Proposal_Chronic_Care_Coordination-1-AU.doc• To be updated

Page 20

GAPS AND WORKPLAN

Page 21

Gaps

Page 22

Workplan

• High level here, comprehensive on Excel• There was a work plan

PC CarePlanTopic Planning & Controllist_v02.xls

Page 23

TEAM AND ROLES

Page 24

Team and Roles (WIP)

Name email Role Notes

André Boudreau CA a.boudreau@boroan.ca CP Co-Lead

Laura Heermann Langford

US Laura.Heermann@imail.org CP Co-Lead

Stephen Chu AU WG Co-Chair

Peter MacIsaac AU

David Rowed AU

Adel Ghlamallah CA

William Goossen NL WG Co-Chair, DCM

Anneke Goossen NL

Ian Townsend UK

Charlie Bishop UK

Rosemary Kennedy US

Jay Lyle US

ETC. To be augmented

Page 25

Team and Roles- Notes

• Resource issue - the need to fill the roles of HL7 modeling and vocab facilitators to progress the works

Page 26

CONCLUSION

Page 27

Concluding notes

• Approach is OK• Have 1 or 2 or 3 more calls to sort ourselves out• Weekly calls at 17h00 ET

Page 28

Issues/Questions as of 2011-02-09

No. Date Issue Name Comments Owner Status

1

2

3

4

Page 29

Action Items as of 2011-02-09

No. Action Items By Whom For When Done

1. Clarify procedure and obtain rights for André/Laura to update CP wiki William?

2. Do an inventory of use cases and storyboard on hand Laura (student)

3. Ask William for an update (add in a diff colour to the appropriate pages) André

4 Prepare summary of the steps from HDF to produce the DAM André

5 Obtain and share the published version of the CEN Continuity of care P1 and P2 Audrey